Vol 95, No 3 (2014)

Inherited and acquired abnormalities in DNA damage repair system may lead to cancer and other diseases, as well as to act as one of the key factors determining the patient’s responsiveness to chemo- and radiotherapy. Nowadays, the principles of the personalized therapy, based on specific features of disease development and pathogenesis of a solitary organism or in a small group, are applied to treat a broad number of diseases, including cancers. This approach allows to choose the most effective cancer therapy in every single case of cancer, based on the genetic analysis and expression level of specific proteins. One of the promising approaches for increasing the effectiveness of non-surgical cancer treatments - to develop the methods to increase the cancer cells sensitivity to conducted chemotherapy, based on using the DNA repair system defects for the better anti-cancer effect. The review covers some types of DNA repair system defects occurring while chemo- and radiotherapy. Perspectives of the possible influences on DNA repair mechanisms treated as possible targets for both anti-cancer treatment and for increasing the effects of cancer chemo- and radiotherapy, are discussed in the review considering the available published data and results of own research. DNA repair system defects play an important role in cancer genesis, but as well can determine the good response of patients with such defects to chemo- and radiotherapy (inducing different types of DNA damage).

Aim. To study the distribution of cardiovascular risk factors, target organ damage, associated clinical conditions and to stratify the 10-year risk of arterial hypertension complications in menopausal females depending on presence of inappropriately high left ventricular mass. Methods. 107 females from city of Kazan aged 42-59 years entered the study, including 11 women with normal blood pressure, 16 patients with high normal blood pressure, and 80 patients with hypertension according to All-Russia scientific Society of Cardiologists classification (2010) with disease duration of 0-34 years. Mean age of patients with hypertension was 51.4±4.0 years. Patients with secondary hypertension were excluded from the study. All patients underwent a questionnaire survey, physical examination, biochemical blood test, ECG, echocardiography, and cervical extracranial vessel ultrasonography. Actual left ventricle mass was calculated according to R.B. Devereux et al. (1977) and was adjusted to the body surface area. Proper left ventricle mass was defined by G. Simone et al. (1998). Disproportion coefficient was calculated as a ratio of actual left ventricle mass to proper left ventricle mass. Left ventricle hypertrophy was diagnosed using the Sokolow-Lyon index and left ventricle mass index ≥ 110 g/m2 (Echo-signs of left ventricle hypertrophy). Results. In menopausal women, inappropriately high left ventricular mass was associated with significantly (р <0.05, Fisher exact test) higher frequency of obesity, especially its abdominal type, as well as target organ damage, including Echo-signs of left ventricle hypertrophy, very high added 10-year risk of developing arterial hypertension complications. It was also associated with significantly (р <0.05, the U-criterion) higher mean values of waist circumference, waist to hip circumference ratio, body mass index, total number of damaged target organs and 10-year risk for developing arterial hypertension complications. Conclusion. Distinguishing the patients with inappropriately high left ventricular mass among menopausal women is important for planning the measures to prevent cardiovascular events.

АIM. To study the effect of L-arginine on endothelium-dependent vasodilatation in patients with congenital mitral valve prolapse and different degrees of regurgitation. Methods. The study included 86 patients [36 (41.9%) males and 50 (58.1%) females aged 15-25 (mean age 19.9±1.42) years] with signs of congenital mitral valve prolapse. The first group included 41 patients were L-arginine (Tivortin) as a prophylaxis medication. The second group included 45 patients who were not taking L-arginine. Subgroup A of each group included 20 and 22 patients with stage I of mitral regurgitation, accordingly; subgroup B of each group included 21 and 23 patients with stage II of mitral regurgitation, accordingly. Results. In patients of the first group with mitral valve prolapse and stages I and II of mitral regurgitation, distinct positive changes were observed after 6 months of treatment with L-arginine. Compared to baseline data, in patients of the first group with stage I of mitral regurgitation brachial artery diameter increased by 1,44 times (р <0.001), resistance index - by 1.5 times (р <0.001); in patients with stage II of mitral regurgitation the following parameters increased by 1.65 and 1.39 times (р <0.001 and р <0.01) accordingly. At the same time, parameters of NO-system also improved in patients of the first group with stages I and II of mitral regurgitation after 6 months of treatment: endothelial NO synthase activity increased by 1.18 and 1.29 times (р <0.05 and р <0.02) accordingly, NO level decreased by 1.17 and 1.18 times (р <0.05), inducible NO synthase activity - by 1.17 and 1.29 times (р <0.05 and р <0.02), and there was a reduction of peroxynitrite levels by 1.23 and 1.34 times (р <0.02 and р <0.01), endotheline-1 - by 1.07 and 1.26 times (р <0.05 and р <0.02), vascular endothelial growth factor - by 1.08 and 1.24 times (р <0.05 and р <0.01) accordingly. Conclusion. Recommended doses of L-arginine restores the stream-dependent vasodilation, activity of the NO-system and process of angiogenesis after 6 months of treatment.

Aim. To study the effect of phospholipids for lipid metabolism normalization in adolescents with metabolic syndrome. Methods. The study included 50 adolescents aged 12 to 17 years with the diagnosis of metabolic syndrome according to 2007 criteria of International Diabetes Federation. All of them had dyslipidemia and nonalcoholic fatty liver disease in the stage of steatosis, steatohepatitis. The adolescents were splitted into two groups: the treatment group (30 patients) and the control group (20 patients). Patients of the first group, as an addition to the standard treatment (metformin), took phospholipids (Rezalut) 2 capsules three times a day for 2 months, followed by a second course after 2 months gap. Patients of the first group were treated by the standard treatment only. The statistical analysis was performed by the methods of parametric and nonparametric statistics using «Statistica 6.0» software. Results. After 3 months of treatment, there was a body weight and body mass index decrease in patients of the treatment group, the difference between the groups was statistically significant (р <0.05), and preserved so after 6 months of treatment compared both to baseline data and to controls. Serum cholesterol, low-density lipids levels decreased, high-density lipids levels increased in patients of the first group, reducing the atherogenic index of plasma. No significant changes of these parameters was observed in the second group. Liver enzymes (aspartate aminotransferase, alanine aminotransferase) levels reduced significantly (р <0.05) in the treatment group compared with baseline levels; no such changes were observed in the control group. Conclusion. Prescribing phospholipids as part of the complex treatment of the metabolic syndrome is pathogenically justified.

Aim. To estimate and compare the features and efficacy of different surgical methods of pelvic organ prolapse correction. Methods. 120 patients with stage 4 of pelvis organ prolapse were included in the study. The different types of surgical procedures were performed («Manchester» surgery, vaginal hysterectomy, sacropexy, laparoscopic ventrosuspension). Surgical method was selected accounting the patient’s age, desire to save the uterus, presence of uterine or adnexal pathology and concomitant diseases. For long-term outcomes evaluation, patients were followed up for 6-36 month after surgery. Results. The long-term outcomes of the different types of surgeries performed in patients with stage 4 of pelvis organ prolapse were comparable. Minimal surgery time, blood loss and the hospital stay were registered in patients, in whom laparoscopic ventrosuspension combined with colpoperineorrhaphy and levatorplasty was performed, compared to «Manchester» surgery, vaginal hysterectomy and sacropexy with colpoperineoplasty. No cases of serious complications were registered. Patients with stress incontinence observed before surgery reported improvement in urination, although 6 patients (10%) still reported rare episodes of incontinence. Conclusion. In elderly patients with stage 4 of pelvis organ prolapse, laparoscopic ventrosuspension of uterus or vaginal stump with further colpoperineorrhaphy and levatorplasty could be performed; this type of surgery is technically simple, not time-consuming, and it’s results are comparable with the effectiveness of sacropexia. Thus, it could be recommended to under-trained young surgeons.

Aim. To assess functional condition of the nasal cavity, paranasal sinuses, pharynx in patients with remission of chronic obstructive pulmonary disease. Methods. Patients were distributed to 2 groups. The main group included 49 patients with stages II and III of chronic obstructive pulmonary disease in remission, control group included 50 healthy non-smoking volunteers without any known respiratory diseases. Patients underwent general examination, completed by rigid endoscopic examination, examination of ciliary clearance, anterior active rhinomanometry, olfactometry, nasal cavity and paranasal sinuses computed tomography. Pharynx examination included nasal cavity posterior endoscopy, mesopharyngoscopy, lower part of the parynx was examined by rigid endoscope with viewing angle of 70°. Results. Ciliary clearance was 26.7±3.06 minutes in patients of the main group, compared to 16.4±1.11 minutes in patients of the control group. Smell acuity was 1.86±0.11 units in patients of the main group, compared to 2.3±0.15 units in patients of the control group. Signs of nasal and pharyngeal diseases, including signs of chronic inflammation of nasal mucosa and chronic catarrhal pharyngitis was found in 30 patients. Conclusion. Patients with chronic obstructive pulmonary disease had higher prevalence of chronic rhinitis and pharyngitis, worse smell acuity and impaired ciliary clearance compared to healthy controls.

Aim. To determine the gender differences in risk factors of left ventricular remodeling in patients with chronic heart failure associated with arterial hypertension and coronary heart disease. Methods. The study included 112 patients aged 45 to 60 years with myocardial scaring after myocardial infarction and functional class I-III of heart failure by NYHA. Patients were distributed to 2 groups: 1st included 60 males (mean age 54.8±3.3 years), 2nd - 52 females (mean age 55.8±3.1 years). To assess the cardiac function, all patients underwent echocardiography (B- and M-modes). Models of left ventricle architectonics were identified according to such parameters as left ventricle wall relative thickness index and left ventricular mass index. Results. Leading causes for heart failure in female patients were hypertension (50% of cases) and ischemic heart disease (23.1% of cases, 79.5% of ischemic heart disease cases were not associated). In males, ischemic heart disease was the leading reason for chronic heart failure (78.3% of cases, among them 80.9% with a history of survived myocardial infarction). In females, chronic heart failure was more often associated with isolated diastolic dysfunction (78.8% of cases versus 65% in males, p <0.05), and left ventricle ejection fraction was stable. Unfavorable types of left ventricle remodeling in terms of prognosis were more common among females, including eccentric left ventricle hypertrophy (67.3% of cases versus 53.3% in males, p <0.05) and concentric left ventricle hypertrophy (21% of cases versus 18.3% in males, p >0.05). Conclusion. There are gender differences in patients with chronic heart failure: prevalence of hypertension in women, and coronary heart disease in men; higher rate of isolated diastolic dysfunction prognostically unfavorable types of left ventricle remodeling (eccentric and concentric left ventricle hypertrophy) in females.

Aim. To assess the effect of dynamic electroneurostimulation in treatment of community-acquired pneumonia in preschool children. Methods. The main group consisted of 45 preschool children with community-acquired pneumonia, in whom 7-day treatment course of dynamic electroneurostimulation was included as the component of the complex treatment. The control group included 55 children in whom conventional tactics was applied. Results. General intoxication syndrome was resolved at 3.2±1.1 day in children of the main group compared to 7.7±1.4 day in the control group. The use of dynamic electroneurostimulation reduced the duration of respiratory distress by more than 1.5 times (6.8±1.3 day), regression of physical lung changes was observed at 10.3±1.4 on average, compared to the end of the second week at the control group. Resolving of the clinical symptoms in children of the main group was accompanied by statistically significant (p <0.05) reduction of basic parameters of systemic inflammation (increased white blood cells count, high neutrophil count, left shift) by 7th day of treatment. The level of C-reactive protein reduced by 7 times in children of the main group, compared to 2.3 times in comparison group (p <0.05). Chest X-ray on the 7th day showed complete resolving of inflammatory changes in 20 (44.4%) patients of the main group, while no such cases were observed in control group (p <0.001). At the same time, no positive change of X-ray picture was revealed in 25 (45.5%) children of the control group, while there were no such cases in the main group (p <0.001). On the 11th day of treatment complete resolving of inflammatory changes was found in 43 (95.6%) children of the main group, compared to 34 (61.8%) children of the control group (p <0.05). Conclusion. Including of dynamic electroneurostimulation in complex treatment of community-acquired pneumonia in children reduces the recovery time, hospital stay and treatment cost.

Aim. To match up the proliferative activity of colon adenocarcinoma cells with tumor stage and survival rate. Methods. Ki-67 protein expression was evaluated by immunohistochemical methods in 217 patients with primary colon adenocarcinoma. After epitope retrieval and endogenous peroxidase inhibiting by 3% solution of hydrogen peroxide, histologic samples were stained by antibodies to Ki-67 protein (clone SP6, dilution 1:300) and polymer systemic detection with diaminobenzidine as a chromogenic substrate. Nuclear counterstain was performed using Mayer’s hematoxylin solution. Results. Assessment of colon adenocarcinoma proliferative activity showed a significant difference between the number of cases with high (>70%) and relatively low (≤30%) proliferative levels in groups with metastatic cancers and non-metastatic tumors. In patients with no relapses, colon adenocarcinoma proliferative activity assessment showed proliferation level exceeding 70% in 21 (95%) out of 22 cases, in a single case proliferation level of 60% was found according to Ki-67, no cases of proliferation level lower than 50% was found. Statistical analysis showed that proliferative activity was significantly lower in patients with metastatic colon adenocarcinoma compared to cases of adenocarcinoma without metastases (p= 0.0019). We observe one clinical case of aggressive colon adenocarcinoma with omental, peritoneal, paraumbilical metastases in 28-year old patient, in whom proliferative activity by Ki-67 was measured as 20%. Conclusion. Low proliferative level in colon adenocarcinoma is a poor prognostic factor for possible metastasing and cancer recurrence.

Aim. To study the hemostasis at the pre-reactive period of cold injury occurred at the third stage of the decompensated phase of general casual hypothermia. Methods. Experiments were performed on on 23 Wistar rats. General casual hypothermia was simulated by placing the animals in individual cages in a freezer with in-temperature of -25 °C. Animals were kept in the freezer until the rectal body temperature of +30 °С. Blood samples of 10 animals, kept at 22°C during the same exposure time, were used as a control. Hemostasis parameters, including platelets and coagulation panel, as well as blood serum anticoagulant and fibrinolytic activity, were assessed in peripheral blood. Induced platelet aggregation was measured by aggregometer, with 10 μg/ml adenosine diphosphate solution as the inductor. Results. General casual hypothermia was not associates with changes in the peripheral blood. At the same time, increased platelet count by 19% (р <0.05) and reduced platelet aggregation activity by 9 times (р <0.05) was observed. The coagulation panel at the pre-reactive period of cold injury was associated with Echitox coagulation time increase by 42% (р <0.05), together with fibrinogen concentration drop by 25% (р <0.05). Increased polymerization time of circulating soluble fibrin monomer complexes by 36% (р <0.05) was suggestive of reduced I clotting factor serum concentrations. In the same animals, the serum concentration of soluble fibrin monomer complexes was increased by 96% (р <0.05), suggesting the increased clotting activity. Conclusion. Decompensated phase of general casual hypothermia was associated with significant changes of on the hemostasis. The set of observed changes was suggestive of increased clotting activity as the response to the cold trauma and predisposition to clotting in experimental animals.

Aim. To perform the comparative analysis of osteosynthesis stability in splintered fractures on the example of modeled fractures of femur with metalwork. Methods. Bone fragments fixation methods using internal fixators, blocking intramedullary nails, external fixation devices. Round wooden rod with external diameter of 35 mm, internal diameter of 25 mm, which was saw in the middle with two cuts directed at an angle of 45° to the rod axis to form the triangle fragment, was picked for femur model for the purpose of experiment. The stability of bone fragments fixation using plates with angle stability, pin- and nail-type external fixation devices and blocking intramedullary nails was assessed. To test the stability of the «bone-fixing device» complex, torsional test machine КМ-50-1 №66, power press П-10 №92, pull test machine Р-10 №1677 were used. Results. Compared to external fixation device, fixation using plates with angle stability was 6 times more stable at axial load and by 43.5% at lateral load. The stability of blocking intramedullary nail at axial load was higher compared to external fixation device. At rotary load, the stability of blocking intramedullary nail was 2 times lower compared to external fixation device. Conclusion. On a model of splintered double-lever femur fractures, fixation using plates with angle stability was the most stable fixation mode.

Aim. To detect the features of immune status at prenatal and early postnatal periods under the influence of Toxoplasma gondii antigens. Methods. The experimental study was performed on Wistar white rats, who were the offspring of the female rats who were sensitized by T. gondii corpuscular antigen during the III trimester of pregnancy - group 1 (n=96) and on animals who were administered T. gondii corpuscular antigen at firs day of life - group 2 (n=103). Control group consisted of intact rats. Common blood test, levels of antibody-forming cells and CD3+ cells were assessed at 60 day after birth. Results. Neutrophil blood count was 1.9 times higher in the group 1 rats compared to group 2. Eosinophil blood count was 1.4 times lower in the group 1 compared to control group (р=0.01), and 2 times lower in the group 2 compared to control group (р=0.002). At the same time, lymphocyte count was comparable in the group 1 rats and control group, while it was 1.4 times lower in the group 2 compared to control group (р=0.04). Together with that, there was a reduction of CD3+ cells and antibody-forming cells in blood and spleen, which was more marked in the 2nd group. Lymphoadenopathy, thymus dysgenesia, reduced blood and spleen T-cells levels, low humeral immunity were found in Wistar white rats, who were the offspring of the female rats who were sensitized by T. gondii corpuscular antigen during the III trimester of pregnancy. Conclusion. The influence T. gondii corpuscular antigen on rats during perinatal period results in secondary immunodeficiency, persisting at 60 day of life.

The aim of the study is to analyze possible options for treating patients with deep paraprothetic infection of major joints performing a literature review. Arthroplasty has occupied its specific place in a range of surgical operations used in treating patients with joint diseases. The rate of possible complications developing on different stages of treatment does not decrease while the number of operations increase. The most difficulties are associated with deep paraprothetic infection, because in this case in is only possible to save the implant in 20% of patients mainly with early infections. The rate for infective complications in specialized orthopedic centers while ward treatment does not exceed 1% in case of primary arthroplasty, but significantly increases several years after the surgery. The most used treatment for paraprothetic infection is serial revision arthroplasty. The comparative analysis of single-staged and two-staged treatment was performed. The second one is based on using antibiotic-loaded bone cement spacers. The analysis reveals that using antibiotic-loaded bone cement spacers is an effective method of treatment for deep paraprothetic infection. Two-staged treatment method with temporary spacer implantation is preferable in treating infective complications of arthroplasty. Furhter progress of this method may be associated with optimizing the choice of antibiotic filling, developing new spacer structures and forms, and in combining local and general antibiotic administration.

Aim. To analyze the incidence and mortality from malignancies in the Amur Oblast. Methods. The evaluation was based on statistical data analysis of incidence and mortality from malignancies. Results. Incidence of malignancies in the last 5 years in the Amur Oblast increased up to 346.3 per 100 000 in 2012. Main localizations for malignancies were: the first place - lung malignancies; the second - skin malignancies; the third - breast malignancies; the fourth -stomach malignancies (41.1, 39.7, 37.3, 23.9 per 100 000 accordingly). The areas with the highest prevalence of cancers - Konstantinovsky, Zavitinsky, Bureysky, Zeysky districts - were outlined, with the prevalence of 441.9; 438.7; 420.6 and 384.4 per 100 000 per year. Mortality from cancer in the Amur Oblast in 2012 was 180.7 per 100 000, one-year mortality rate increased to 31.8%. The most frequent cancer types leading to unfavorable outcomes were malignancies of digestive organs - 34.9% of all fatal outcomes, respiratory system organs - 24.2%, female reproductive system - 6.6%, breast - 6.5%, kidneys and urinary tract - 6.01%. Conclusion. The incidence and mortality from malignancies in the Amur Oblast increased in 2012 compared to 2008.

Aim. The research goal was to evaluate the ethnical and epidemiological characteristics of the deceased HIV-infected patients in the Republic of Tatarstan. Methods. Causes of death among HIV-infected patients were analyzed. Depending on ethnicity they were divided into two groups: group 1 (n=276, 71.1%) - Russian nationality, group 2 (n=112, 28.9%) - Tatar nationality. Results. Mortality of HIV-infected persons of group 1 was 3.2 times higher than among patients of group 2 (18.4 and 5.6 per 100 000 respectively, p <0.001). In both groups majority of patients (79.0 and 62.5% in 1 and 2 groups) were infected through drug injections. Highest mortality rate was observed in HIV-infected males younger than 40 years who lived in urban areas and was associated with tuberculosis, lung and cardiovascular diseases. The mean disease duration after diagnosis in the 1st and 2nd groups was similar (5.2±0.3 and 5.1±0.4 years, respectively). Shorter survival period was observed in females, older than 50 years, persons infected through sexual contact and patients with comorbidities. Conclusion. In the Republic of Tatarstan mortality among HIV-infected persons of Russian nationality was higher than in a group with Tatar nationality. Disease duration of HIV-infected persons had no association with their ethnic group.

Aim. To define the mineral content in foods supplied for preschool facilities in Irkutsk by laboratory methods. Methods. Food samples (whole cow milk, white bread, potato, apple, beef, «Gerkules» oat) were analyzed. The results were compared with data of food chemical contents used as reference values by «Center for Biotic Medicine» for evaluating food mineral contents. Analytic tests were performed using atomic emission spectroscopy with inductively coupled argon plasma and mass spectroscopy with inductively coupled argon plasma. Results. Food samples analysis in preschool facilities of Irkutsk revealed that these samples have significant differences in mineral contents compared with foods used in the European part of Russia. In common, examined foods contains less macro- and microelements, especially Ca, Fe, P, Si. In animal products (milk, meat) the differences were more significant both in number of elements and in absolute differences, compared to plant food (bread, potato, apple, cereal). Animal products contains less zinc. Conclusion. The gained data highlight the need for improving children’s catering, as well as for development and use of preventive measures aimed to reduce risks for diseases associated with macro- and microelements deficiencies.

By 01.01.2013 in the Republic of Tatarstan there were 23 970 Hepatitis B Surface Antigen carriers and 4546 patients with active Hepatitis B out of 28 516 registered patients who were infected with Hepatitis B. Our experience shows that not only inactive chronic Hepatitis B Surface Antigen carriers, but also patients with different clinical forms of Hepatitis B might be estimated as Hepatitis B Surface Antigen carriers. The feature of chronic viral hepatitides is a discrepancy between the scarce clinical picture and presence (in 15-30% of cases) of active inflammation in liver tissue. Since 2009, patients with positive ELISA test for antibodies to Hepatitis C virus are no longer registered in the national registry of infective diseases of Russian Federation. In the Republic of Tatarstan, such patients with antibodies to Hepatitis C virus were still registered up to 2012 (50 266 patients were registered by 01.01.2012). According to our own data, Hepatitis C viral RNA was found at polymerase chain reaction to Hepatitis C virus in 61% of cases out of 957 patients tested. According to our own data, when using the combined treatment (interferon alpha and ribavirin), lasting virologic response was obtained in 65.7% cases of type 1 genotype of Hepatitis C and almost in 100% of cases of other genotypes out of 163 cases of chronic Hepatitis C, which corresponds to worldwide standards. By 01.01.2013, 295 patients with liver cirrhosis as the result of chronic Hepatitis C were followed up at the consultative and diagnostic center of Republican Clinical Hospital of Infective Diseases with the upward trend. The retrospective analysis of 130 case histories of patients with liver cirrhosis revealed that Hepatitis C was firstly diagnosed at the stage of established liver cirrhosis in 57.7% of cases. Timely diagnosis and periodic medical examination in cases of chronic Hepatitis C allows to implement the individual, personalized approach in such patients and to choose the adequate treatment and follow-up.

Aim. To assess the clinical value of continuous monitoring of rheographic parameters in patients with high risk of recurrent gastrointestinal bleeding for early pre-clinical diagnosis of recurrent bleeding. Methods. The study included 50 patients with upper gastrointestinal bleeding aged 50 to 70 years who were admitted having hemorrhagic shock III after endoscopic hemostasis. Continuous integral whole body rheography by «Diamant-M» computer complex was used for systemic circulation assessment. Results. Three types of hemodynamic reactions were revealed at integral whole body rheography: hypertonic (35 cases: increased integral tonicity coefficient up to 86 units and total peripheral vascular resistance over 3000 dyn/s·cm-5), hypotonic (35 cases: decreased integral tonicity coefficient down to 77 units and less, total peripheral vascular resistance less than 1500 dyn/s·cm-5, possible M-like waves of rheography curve) and intermediate (integral tonicity coefficient between 77 and 83 units, total peripheral vascular resistance between 1500 and 2000 dyn/s·cm-5). Integral tonicity coefficient between 80 and 113 units and total peripheral vascular resistance between 1500 and 3000±120 dyn/s·cm-5 were important indicators while monitoring for possible recurrent gastrointestinal bleeding. Conclusion. Blood loss compensation monitoring by continuous non-invasive rheography in patients at high risk for recurrent gastrointestinal bleeding allows not only diagnose recurrent gastrointestinal bleeding in a timely manner, but also to assess the effect of the treatment conducted.

The greater saphenous vein is the most available and frequently used conduit for coronary artery bypass grafting. Conventional (open) vein harvesting procedure requires the longitudinal skin and subcutaneous fat incision along the full conduit length. Endoscopic vein harvesting has been developed in the middle-1990s as less invasive alternative for open vein harvesting. Using this novel technique allows to harvest the whole greater saphenous vein through 3 cm long skin incision. The article reviews the history, the role and current status of endoscopic vein harvesting in coronary artery bypass surgery. Literature data of the impact of that minimally invasive approach on infective and non-infective leg wound complications, as well as postoperative pain, patient satisfaction and live quality are presented. The cost-effectiveness data of the method, resulting in reduction of treatment costs of leg wound complications both at the hospital and after patient’s discharge are mentioned. The influence of endoscopic vein harvesting on morphologic and functional conduit quality is discussed. Special attention is devoted to mid- and long-term outcomes after coronary artery bypass surgery with endoscopic vein harvesting. The majority of research including angiographic control gives evidence of comparable parameters of bypass patency after the conventional vein harvesting and endoscopic vein harvesting procedures. Recent multicenter trials showed no statistically significant differences between the conventional vein harvesting and endoscopic vein harvesting procedures in such indirect graft patency indicators as mortality, myocardial infarction rate, need for repeated revascularization and recurrence of angina pectoris. Recent findings advocate safety and clinical effectiveness of endoscopic vein harvesting.

Issues of deontological ethics in medicine were discussed in numerous papers, including publications of special conferences. N.N. Petrov in his book wrote: «Surgery depends on science, which is continuously growing and expanding. It also depends on the technique: hand, instrumental, electric, continuously developing and simplifying facing seemingly insurmountable difficulties. Teachers provide information about the science, and techniques to young surgeons, of whom all are keenly interested in it. But surgery is not limited to science and technology. Painfully affecting the human body, getting deeply inside it, surgery reaches the top of its opportunities only in case when it is decorated with the highest manifestation of selfless care of the sick person, and that not only of his body, but also about the state of his mind». Much has changed during this period of time, more accurate diagnostic methods appeared, unprecedented success was achieved in anesthesiology and critical care. The article covers questions related to ethics arising while treating patients with malignancies. Various aspects of deontological ethics, i.e. proper attitude and decisions while treating patients with malignancies, have certain features specific for surgical oncology. Questions of contraindications to surgery are solved at different stages of the patient treatment: during outpatient examination, exploration, at operation itself, after completing surgery. Some examples of ethical errors are given. Conclusion on refusing the surgery should be, in every case, absolutely reliable, rigorously documented, which prohibits false solutions. Decision should be based on a clear understanding of the pathogenesis of the patient’s body changes in each case. The questions of indications for surgery, its feasibility and extent should be decided ex concilio.

Aim. To determine the association between the systolic arterial blood pressure level and the inter-arm asymmetry measurements in healthy individuals. Methods. 580 healthy volunteers aged 20 to 60 years (401 females, 179 males) were included in the study. Arterial blood pressure was measured in both left and right wrists using an automatic blood pressure sensor with the detector of hand position in a quiet, comfortable environment. Depending on the systolic arterial blood pressure level on the left arm, subjects were distributed to 5 groups: the 1st - blood pressure of 99 mm Hg and lower; 2nd - 100-119; 3rd - 120-129; 4th - 130-139; 5th -140 and over. Each group were further subdivided to 3 subgroups depending on the inter-arm blood pressure level asymmetry (difference of blood pressure levels on both arms): 1st - symmetry, 2nd - acceptable asymmetry (not exceeding 15 mm Hg), 3rd - abnormal asymmetry (16 mm Hg and over). Results. The major part of the examined subjects had systolic arterial blood pressure level between 100 and 119 mm Hg, systolic blood pressure below 99 mm Hg was registered more rarely. Among 580 examined subjects, abnormal asymmetry was more frequently seen in patients with blood pressure below 99 mm Hg and exceeding 140 mm Hg, the lowest frewuency was in the group with blood pressure between 120 and 129 mm Hg. The right arm was the dominating arm for the asymmetry in subjects with blood pressure below 119 mm Hg, in other cases the dominating arm was not determined. Conclusion. The study demonstrates the presence of vascular inter-arm asymmetry in systolic blood pressure in individuals who perceive themselves as healthy. Inter-arm asymmetry depended on the level of systolic arterial blood pressure.